|
HC NM BONE SINGLE AREA
|
Facility
|
IP
|
$1,204.47
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$782.91 |
| Max. Negotiated Rate |
$1,084.02 |
| Rate for Payer: Aetna Commercial |
$1,023.80
|
| Rate for Payer: BCBS Trust/PPO |
$983.21
|
| Rate for Payer: BCN Commercial |
$930.81
|
| Rate for Payer: Cash Price |
$963.58
|
| Rate for Payer: Cofinity Commercial |
$1,035.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.58
|
| Rate for Payer: Healthscope Commercial |
$1,084.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$903.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.80
|
| Rate for Payer: Nomi Health Commercial |
$987.67
|
| Rate for Payer: PHP Commercial |
$1,023.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.91
|
| Rate for Payer: Priority Health HMO/PPO |
$1,047.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$806.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,059.93
|
| Rate for Payer: UHC Core |
$1,005.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$903.35
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
OP
|
$1,765.95
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,589.36 |
| Rate for Payer: Aetna Commercial |
$1,501.06
|
| Rate for Payer: Aetna Medicare |
$459.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.86
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$441.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,451.79
|
| Rate for Payer: BCN Commercial |
$1,373.03
|
| Rate for Payer: BCN Medicare Advantage |
$441.49
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cofinity Commercial |
$1,518.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,412.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.49
|
| Rate for Payer: Healthscope Commercial |
$1,589.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,324.46
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.56
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,501.06
|
| Rate for Payer: Nomi Health Commercial |
$1,448.08
|
| Rate for Payer: PACE Senior Care Partners |
$419.41
|
| Rate for Payer: PACE SWMI |
$441.49
|
| Rate for Payer: PHP Commercial |
$1,501.06
|
| Rate for Payer: PHP Medicare Advantage |
$441.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1,536.38
|
| Rate for Payer: Priority Health Medicare |
$445.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,183.19
|
| Rate for Payer: Railroad Medicare Medicare |
$441.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,554.04
|
| Rate for Payer: UHC Core |
$1,474.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.49
|
| Rate for Payer: UHC Exchange |
$441.49
|
| Rate for Payer: UHC Medicare Advantage |
$441.49
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$441.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,324.46
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
IP
|
$1,765.95
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,147.87 |
| Max. Negotiated Rate |
$1,589.36 |
| Rate for Payer: Aetna Commercial |
$1,501.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,441.54
|
| Rate for Payer: BCN Commercial |
$1,364.73
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cofinity Commercial |
$1,518.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,412.76
|
| Rate for Payer: Healthscope Commercial |
$1,589.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,324.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,501.06
|
| Rate for Payer: Nomi Health Commercial |
$1,448.08
|
| Rate for Payer: PHP Commercial |
$1,501.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1,536.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,183.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,554.04
|
| Rate for Payer: UHC Core |
$1,474.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,324.46
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
IP
|
$1,735.24
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,127.91 |
| Max. Negotiated Rate |
$1,561.72 |
| Rate for Payer: Aetna Commercial |
$1,474.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,416.48
|
| Rate for Payer: BCN Commercial |
$1,340.99
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cofinity Commercial |
$1,492.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.19
|
| Rate for Payer: Healthscope Commercial |
$1,561.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,301.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.95
|
| Rate for Payer: Nomi Health Commercial |
$1,422.90
|
| Rate for Payer: PHP Commercial |
$1,474.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.91
|
| Rate for Payer: Priority Health HMO/PPO |
$1,509.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,162.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,527.01
|
| Rate for Payer: UHC Core |
$1,448.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,301.43
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
OP
|
$1,735.24
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,561.72 |
| Rate for Payer: Aetna Commercial |
$1,474.95
|
| Rate for Payer: Aetna Medicare |
$451.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$542.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$542.26
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$433.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.54
|
| Rate for Payer: BCN Commercial |
$1,349.15
|
| Rate for Payer: BCN Medicare Advantage |
$433.81
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cofinity Commercial |
$1,492.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.81
|
| Rate for Payer: Healthscope Commercial |
$1,561.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,301.43
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.50
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$498.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.95
|
| Rate for Payer: Nomi Health Commercial |
$1,422.90
|
| Rate for Payer: PACE Senior Care Partners |
$412.12
|
| Rate for Payer: PACE SWMI |
$433.81
|
| Rate for Payer: PHP Commercial |
$1,474.95
|
| Rate for Payer: PHP Medicare Advantage |
$433.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.91
|
| Rate for Payer: Priority Health HMO/PPO |
$1,509.66
|
| Rate for Payer: Priority Health Medicare |
$438.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,162.61
|
| Rate for Payer: Railroad Medicare Medicare |
$433.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,527.01
|
| Rate for Payer: UHC Core |
$1,448.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.81
|
| Rate for Payer: UHC Exchange |
$433.81
|
| Rate for Payer: UHC Medicare Advantage |
$433.81
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$433.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,301.43
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
IP
|
$1,296.09
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$842.46 |
| Max. Negotiated Rate |
$1,166.48 |
| Rate for Payer: Aetna Commercial |
$1,101.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.00
|
| Rate for Payer: BCN Commercial |
$1,001.62
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$1,114.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Healthscope Commercial |
$1,166.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$972.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.68
|
| Rate for Payer: Nomi Health Commercial |
$1,062.79
|
| Rate for Payer: PHP Commercial |
$1,101.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.46
|
| Rate for Payer: Priority Health HMO/PPO |
$1,127.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$868.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,140.56
|
| Rate for Payer: UHC Core |
$1,082.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$972.07
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
OP
|
$1,296.09
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,166.48 |
| Rate for Payer: Aetna Commercial |
$1,101.68
|
| Rate for Payer: Aetna Medicare |
$336.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.03
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$324.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.52
|
| Rate for Payer: BCN Commercial |
$1,007.71
|
| Rate for Payer: BCN Medicare Advantage |
$324.02
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$1,114.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.02
|
| Rate for Payer: Healthscope Commercial |
$1,166.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$972.07
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.22
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.68
|
| Rate for Payer: Nomi Health Commercial |
$1,062.79
|
| Rate for Payer: PACE Senior Care Partners |
$307.82
|
| Rate for Payer: PACE SWMI |
$324.02
|
| Rate for Payer: PHP Commercial |
$1,101.68
|
| Rate for Payer: PHP Medicare Advantage |
$324.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.46
|
| Rate for Payer: Priority Health HMO/PPO |
$1,127.60
|
| Rate for Payer: Priority Health Medicare |
$327.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$868.38
|
| Rate for Payer: Railroad Medicare Medicare |
$324.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,140.56
|
| Rate for Payer: UHC Core |
$1,082.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.02
|
| Rate for Payer: UHC Exchange |
$324.02
|
| Rate for Payer: UHC Medicare Advantage |
$324.02
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$324.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$972.07
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
OP
|
$1,183.46
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$1,065.11 |
| Rate for Payer: Aetna Commercial |
$1,005.94
|
| Rate for Payer: Aetna Medicare |
$307.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$369.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$369.83
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$295.87
|
| Rate for Payer: BCBS Trust/PPO |
$972.92
|
| Rate for Payer: BCN Commercial |
$920.14
|
| Rate for Payer: BCN Medicare Advantage |
$295.87
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cofinity Commercial |
$1,017.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.87
|
| Rate for Payer: Healthscope Commercial |
$1,065.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.60
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.66
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.94
|
| Rate for Payer: Nomi Health Commercial |
$970.44
|
| Rate for Payer: PACE Senior Care Partners |
$281.07
|
| Rate for Payer: PACE SWMI |
$295.87
|
| Rate for Payer: PHP Commercial |
$1,005.94
|
| Rate for Payer: PHP Medicare Advantage |
$295.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,029.61
|
| Rate for Payer: Priority Health Medicare |
$298.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$792.92
|
| Rate for Payer: Railroad Medicare Medicare |
$295.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,041.44
|
| Rate for Payer: UHC Core |
$988.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.87
|
| Rate for Payer: UHC Exchange |
$295.87
|
| Rate for Payer: UHC Medicare Advantage |
$295.87
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$295.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.60
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
IP
|
$1,183.46
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$769.25 |
| Max. Negotiated Rate |
$1,065.11 |
| Rate for Payer: Aetna Commercial |
$1,005.94
|
| Rate for Payer: BCBS Trust/PPO |
$966.06
|
| Rate for Payer: BCN Commercial |
$914.58
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cofinity Commercial |
$1,017.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.77
|
| Rate for Payer: Healthscope Commercial |
$1,065.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.94
|
| Rate for Payer: Nomi Health Commercial |
$970.44
|
| Rate for Payer: PHP Commercial |
$1,005.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,029.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$792.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,041.44
|
| Rate for Payer: UHC Core |
$988.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.60
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
OP
|
$1,326.80
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna Medicare |
$344.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$414.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$414.62
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$331.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.76
|
| Rate for Payer: BCN Commercial |
$1,031.59
|
| Rate for Payer: BCN Medicare Advantage |
$331.70
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.70
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.10
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$348.29
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: Nomi Health Commercial |
$1,087.98
|
| Rate for Payer: PACE Senior Care Partners |
$315.12
|
| Rate for Payer: PACE SWMI |
$331.70
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: PHP Medicare Advantage |
$331.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1,154.32
|
| Rate for Payer: Priority Health Medicare |
$335.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.96
|
| Rate for Payer: Railroad Medicare Medicare |
$331.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.58
|
| Rate for Payer: UHC Core |
$1,107.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$331.70
|
| Rate for Payer: UHC Exchange |
$331.70
|
| Rate for Payer: UHC Medicare Advantage |
$331.70
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$331.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.10
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
IP
|
$1,326.80
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$862.42 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,083.07
|
| Rate for Payer: BCN Commercial |
$1,025.35
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: Nomi Health Commercial |
$1,087.98
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1,154.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.58
|
| Rate for Payer: UHC Core |
$1,107.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.10
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
IP
|
$874.85
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$568.65 |
| Max. Negotiated Rate |
$787.37 |
| Rate for Payer: Aetna Commercial |
$743.62
|
| Rate for Payer: BCBS Trust/PPO |
$714.14
|
| Rate for Payer: BCN Commercial |
$676.08
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$752.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Healthscope Commercial |
$787.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: PHP Commercial |
$743.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: Priority Health HMO/PPO |
$761.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.87
|
| Rate for Payer: UHC Core |
$730.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.14
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$874.85
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$207.78 |
| Max. Negotiated Rate |
$787.37 |
| Rate for Payer: Aetna Commercial |
$743.62
|
| Rate for Payer: Aetna Medicare |
$227.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.39
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$218.71
|
| Rate for Payer: BCBS Trust/PPO |
$719.21
|
| Rate for Payer: BCN Commercial |
$680.20
|
| Rate for Payer: BCN Medicare Advantage |
$218.71
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$752.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.71
|
| Rate for Payer: Healthscope Commercial |
$787.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.14
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.65
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: Nomi Health Commercial |
$717.38
|
| Rate for Payer: PACE Senior Care Partners |
$207.78
|
| Rate for Payer: PACE SWMI |
$218.71
|
| Rate for Payer: PHP Commercial |
$743.62
|
| Rate for Payer: PHP Medicare Advantage |
$218.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: Priority Health HMO/PPO |
$761.12
|
| Rate for Payer: Priority Health Medicare |
$220.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.15
|
| Rate for Payer: Railroad Medicare Medicare |
$218.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.87
|
| Rate for Payer: UHC Core |
$730.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.71
|
| Rate for Payer: UHC Exchange |
$218.71
|
| Rate for Payer: UHC Medicare Advantage |
$218.71
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$218.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.14
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: BCBS Trust/PPO |
$833.26
|
| Rate for Payer: BCN Commercial |
$788.86
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$265.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.99
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$255.19
|
| Rate for Payer: BCBS Trust/PPO |
$839.18
|
| Rate for Payer: BCN Commercial |
$793.66
|
| Rate for Payer: BCN Medicare Advantage |
$255.19
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.19
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.95
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Senior Care Partners |
$242.44
|
| Rate for Payer: PACE SWMI |
$255.19
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$255.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Medicare |
$257.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: Railroad Medicare Medicare |
$255.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.19
|
| Rate for Payer: UHC Exchange |
$255.19
|
| Rate for Payer: UHC Medicare Advantage |
$255.19
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$255.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: BCBS Trust/PPO |
$833.26
|
| Rate for Payer: BCN Commercial |
$788.86
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$991.12 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$265.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.99
|
| Rate for Payer: BCBS Complete |
$991.12
|
| Rate for Payer: BCBS MAPPO |
$255.19
|
| Rate for Payer: BCBS Trust/PPO |
$839.18
|
| Rate for Payer: BCN Commercial |
$793.66
|
| Rate for Payer: BCN Medicare Advantage |
$255.19
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.19
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Mclaren Medicaid |
$943.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.95
|
| Rate for Payer: Meridian Medicaid |
$991.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Senior Care Partners |
$242.44
|
| Rate for Payer: PACE SWMI |
$255.19
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$255.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$943.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Medicare |
$257.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: Railroad Medicare Medicare |
$255.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.19
|
| Rate for Payer: UHC Exchange |
$255.19
|
| Rate for Payer: UHC Medicare Advantage |
$255.19
|
| Rate for Payer: UHCCP Medicaid |
$943.86
|
| Rate for Payer: VA VA |
$255.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.44
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$377.34
|
| Rate for Payer: BCN Commercial |
$356.87
|
| Rate for Payer: BCN Medicare Advantage |
$114.75
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.75
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.49
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PACE Senior Care Partners |
$109.01
|
| Rate for Payer: PACE SWMI |
$114.75
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Medicare |
$115.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: Railroad Medicare Medicare |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.75
|
| Rate for Payer: UHC Exchange |
$114.75
|
| Rate for Payer: UHC Medicare Advantage |
$114.75
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$114.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: BCBS Trust/PPO |
$374.68
|
| Rate for Payer: BCN Commercial |
$354.72
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: BCBS Trust/PPO |
$374.68
|
| Rate for Payer: BCN Commercial |
$354.72
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.44
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$377.34
|
| Rate for Payer: BCN Commercial |
$356.87
|
| Rate for Payer: BCN Medicare Advantage |
$114.75
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.75
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.49
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PACE Senior Care Partners |
$109.01
|
| Rate for Payer: PACE SWMI |
$114.75
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Medicare |
$115.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: Railroad Medicare Medicare |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.75
|
| Rate for Payer: UHC Exchange |
$114.75
|
| Rate for Payer: UHC Medicare Advantage |
$114.75
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$114.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: BCBS Trust/PPO |
$95.75
|
| Rate for Payer: BCN Commercial |
$90.65
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health HMO/PPO |
$102.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.97
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.66
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$29.32
|
| Rate for Payer: BCBS Trust/PPO |
$96.43
|
| Rate for Payer: BCN Commercial |
$91.20
|
| Rate for Payer: BCN Medicare Advantage |
$29.32
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.32
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.97
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.79
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: PACE Senior Care Partners |
$27.86
|
| Rate for Payer: PACE SWMI |
$29.32
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health HMO/PPO |
$102.05
|
| Rate for Payer: Priority Health Medicare |
$29.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.59
|
| Rate for Payer: Railroad Medicare Medicare |
$29.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.32
|
| Rate for Payer: UHC Exchange |
$29.32
|
| Rate for Payer: UHC Medicare Advantage |
$29.32
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$29.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.97
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: BCBS Trust/PPO |
$67.94
|
| Rate for Payer: BCN Commercial |
$64.32
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health HMO/PPO |
$72.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.24
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$18.29
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$68.42
|
| Rate for Payer: BCN Commercial |
$64.71
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$17.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$18.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: PACE Senior Care Partners |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health HMO/PPO |
$72.41
|
| Rate for Payer: Priority Health Medicare |
$21.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.76
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.24
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Exchange |
$20.81
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$17.42
|
| Rate for Payer: VA VA |
$20.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
